QUALIFICATION_SUBMITTAL_FORM_4.26.pdf

166 KB Posted

Attached to
Fiscal Year 2027 Pavement Preservation - Package 1
Solicitation number
26-0361-ITB-C
Issued by
Pinellas County, Clewiston City, Florida

About this file

Written by GovTribe AI ·

This is a Qualification Submittal Form for a pavement preservation project issued by Pinellas County, Florida, for Fiscal Year 2027 Pavement Preservation Package 1. The project consists of four paving locations within Pinellas County, comprising two arterial and two local neighborhood groups, totaling approximately 38.55 lane miles of roadway. Contractors are required to submit completed qualification documentation as part of their bid package. The form requires all contractors to complete an OpenGov Fillable form and submit detailed information on up to four projects of similar scope and size, including project descriptions, owner contact information, project manager contact information, award amounts, final project totals, design professional estimates, change orders, and both scheduled and actual completion dates.

Qualification requirements differ based on FDOT pre-qualification status. Contractors currently pre-qualified with FDOT in all applicable work classes must provide the OpenGov form, qualification documentation, a bonding letter indicating maximum bonding capacity, and a minimum of three reference letters dated within the past five years from companies that have performed similar projects, along with FDOT qualification letters or forms. Non-FDOT pre-qualified contractors must provide the same documentation except they must submit a Florida Certified General Contractor license instead of FDOT qualification materials. Additionally, all contractors must complete the Bid Submittal Officers Form, which requires disclosure of corporate officers (President, Secretary, Treasurer) with their names, titles, and business addresses, or owner and partner information for non-corporate entities, along with contractor registration or certification numbers issued by the State of Florida. Failure to meet any of these qualification conditions results in disqualification from advancing to Step Two of the bidding process.

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QUALIFICATION SUBMITTAL FORM

STEP ONE

FDOT pre-qualified requirements:

If you are currently a pre-qualified construction contractor with FDOT in all the applicable work classes, as required in the Special Conditions Section, please fill out/provide:

1. Please complete and return the OpenGov Fillable-Final.

2. Provide your experience on the Qualification Submittal Form outlining projects of a similar size and scope.

3. A bonding letter from your surety indicating the maximum amount your company can bond.

4. Provide a minimum of three reference letters dated within the past five years from companies that you have performed projects of a similar size and scope.

5. FDOT qualification letter/forms.

Non-FDOT pre-qualified requirements:

If you are not pre-qualified with FDOT in all the applicable work classes, as required in the Special Conditions Section, please fill out/provide:

1. Please complete and return the OpenGov Fillable-Final.

2. Provide your experience on the Qualification Submittal Form outlining projects of a similar size and scope.

3. A bonding letter from surety indicating the maximum amount your company can bond.

4. Provide a minimum of three reference letters dated within the past five years from companies that you have performed projects of a similar size and scope.

5. Provide your Florida Certified General Contractor license.

**If any of the above conditions are not met, your company will be disqualified from moving forward to Step Two. **

Applicable for all contractors. The invitation to bid for this project requires that this form be included with the bid and completed in its entirety.

Company Name: Please include below

Project 1 Description (of similar scope and size)

Owner of Project - Contact Information

Name

Address

Telephone Number and Email Address:

Project Manager - Contact Information

Project Award Amount: $

Final Project Total Amount: $

Design Professional/Engineer Estimate:

$ Change Orders $

Scheduled Completion Date

Actual Completion Date

QUALIFICATION SUBMITTAL FORM (continued)

Project 2 Description (of similar scope and size)

Project Manager - Contact Information

Final Project Total Amount: $

Design Professional/Engineer

Project 3 Description (of similar scope and size)

Project Manager- Contact Information

Final Project Total Amount: $

Design Professional/Engineer

Project 4 Description (of similar scope and size)

Project Manager- Contact Information

Final Project Total Amount: $

Design Professional/Engineer

Applicable only for contractors who are not pre-qualified with FDOT

Vendor Information Firm Name:

Street Address: City: State: ZIP:

Additional Info:

Officer/Director Information

Officer/Director/Member: Title: DOB:

Notes:

Officer/Director/Member: Title: DOB:

Notes:

Officer/Director/Member: Title: DOB:

Notes:

Officer/Director/Member: Title: DOB:

Notes:

Officer/Director/Member Title: DOB:

Notes:

Additional Information: (On Vendor or Contract Requirements)

BID SUBMITTAL OFFICERS FORM

Each Bid by an individual or firm shall state the name and address of each person who owns an interest therein, and, if it is a corporation, the name and address of its officers, or if an LLC, the name and address of its members. Bids shall be signed by the person or member of the firm making the same, and if a corporation, by an authorized officer or agent, subscribing the name of the corporation, together with his/her own name and the corporate seal.

The Bidder further agrees to execute the Agreement within 10 calendar days after receipt of notice of award, and within the time frame of the Agreement.

The Bidder further agrees to bear the full cost of maintaining all Work until final acceptance.

Accompanying the Bid is a Bid Guarantee, meeting the requirements described in the Instruction to Bidders.

The Contractor’s address and principal place of business is:

If Contractor is a Corporation, list the names, titles and business addresses of its President, Secretary and Treasurer.

PRESIDENT ADDRESS:

Printed Name

SECRETARY ADDRESS:

TREASURER ADDRESS:

Said Corporation is qualified to do business in the State of Florida.

Corporate Name:________ ___________________________________

By Title

***CORPORATE SEAL***

Qualifying Agent

Contractor's Registration or Certificate No.

issued by the State of Florida

If Contractor is not a corporation, list the name(s) and business address(es) of its owner(s), joint venturers or partners:

Name ADDRESS:

The said company or business entity is a sole proprietorship, partnership, or joint venture and is trading and doing business as

Company Name:___________________________________________________________

By: ________________________________________________________________________ Name of Firm or Qualifying Agent

Contractor’s Registration or Certification No. issued by the State of Florida

QUALIFICATION SUBMITTAL FORM
STEP ONE
FDOT pre-qualified requirements:
Non-FDOT pre-qualified requirements:
QUALIFICATION SUBMITTAL FORM
Project 1 Description (of similar scope and size)
Owner of Project - Contact Information
Project Manager - Contact Information
Design Professional/Engineer Estimate:
Scheduled Completion Date
Project 2 Description (of similar scope and size)
Owner of Project - Contact Information
Project Manager - Contact Information
Design Professional/Engineer Estimate:
Scheduled Completion Date
Project 3 Description (of similar scope and size)
Owner of Project - Contact Information
Project Manager- Contact Information
Design Professional/Engineer Estimate:
Scheduled Completion Date
Project 4 Description (of similar scope and size)
Owner of Project - Contact Information
Project Manager- Contact Information
Design Professional/Engineer Estimate:
BID SUBMITTAL OFFICERS FORM
PRESIDENT ADDRESS:
SECRETARY ADDRESS:
TREASURER ADDRESS:
Name ADDRESS:
Name ADDRESS:
Name ADDRESS:
Company Name Please include below 1:
Company Name Please include below 2:
Company Name Please include below 3:
Project 1 Description of similar scope and size 1:
Project 1 Description of similar scope and size 2:
Project 1 Description of similar scope and size 3:
Owner of Project Contact Information:
Name:
Address:
Project Manager Contact Information:
Name_2:
Address_2:
Telephone Number and Email Address:
Final Project Total Amount:
undefined:
undefined_2:
1:
2:
Company Name Please include below 1_2:
Company Name Please include below 2_2:
Company Name Please include below 3_2:
Project 2 Description of similar scope and size 1:
Project 2 Description of similar scope and size 2:
Project 2 Description of similar scope and size 3:
Owner of Project Contact Information_2:
Name_3:
Address_3:
Project Manager Contact Information_2:
Name_4:
Address_4:
Telephone Number and Email Address_2:
Final Project Total Amount_2:
undefined_3:
Change Orders:
1_2:
2_2:
Company Name Please include below 1_3:
Company Name Please include below 2_3:
Company Name Please include below 3_3:
Project 3 Description of similar scope and size 1:
Project 3 Description of similar scope and size 2:
Project 3 Description of similar scope and size 3:
Owner of Project Contact Information_3:
Name_5:
Address_5:
Project ManagerContact Information:
Name_6:
Address_6:
Project Award Amount:
Final Project Total Amount_3:
1_3:
2_3:
3:
undefined_4:
Company Name Please include below 1_4:
Company Name Please include below 2_4:
Company Name Please include below 3_4:
Project 4 Description of similar scope and size 1:
Project 4 Description of similar scope and size 2:
Project 4 Description of similar scope and size 3:
Owner of Project Contact Information_4:
Name_7:
Address_7:
Project ManagerContact Information_2:
Name_8:
Address_8:
Telephone Number and Email Address_3:
Final Project Total Amount_4:
undefined_5:
undefined_6:
1_4:
2_4:
Vendor Information:
Firm Name:
Street Address:
City:
State:
ZIP:
Additional Info:
OfficerDirector Information:
OfficerDirectorMember:
Title:
DOB:
Notes:
OfficerDirectorMember_2:
Title_2:
DOB_2:
Notes_2:
OfficerDirectorMember_3:
Title_3:
DOB_3:
Notes_3:
OfficerDirectorMember_4:
Title_4:
DOB_4:
Notes_4:
OfficerDirectorMember_5:
Title_5:
DOB_5:
Notes_5:
Additional Information On Vendor or Contract Requirements:
The Contractors address and principal place of business is 1:
The Contractors address and principal place of business is 2:
The Contractors address and principal place of business is 3:
Printed Name:
ADDRESS 1:
ADDRESS 2:
Printed Name_2:
ADDRESS 1_2:
ADDRESS 2_2:
Printed Name_3:
ADDRESS:
undefined_7:
Title_6:
Qualifying Agent:
Contractors Registration or Certificate No:
Printed Name_4:
ADDRESS_2:
undefined_8:
Printed Name_5:
ADDRESS_3:
Printed Name_6:
ADDRESS_4:
undefined_9:
The said company or business entity is a sole proprietorship partnership or joint venture and:
Company Name:
Name of Firm or Qualifying Agent:
Contractors Registration or Certification No issued by the State of Florida:

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